Early Experience With Neutralizing Monoclonal Antibody Therapy For COVID-19

Jarrett, M. P.; Licht, W. B.; Bock, K.; Brown, Z.; Hirsch, J. S.; Coppa, K.; Brar, R.; Bello, S.; Nash, I. S.

Importance Neutralizing monoclonal antibody (MAB) therapies may benefit patients with mild to moderate COVID-19 at high risk for progressing to severe COVID-19 and/or hospitalization. Objective To describe our experience and patient outcomes of almost 3,000 patients who received MAB infusion therapy at Northwell Health, a large integrated health care system in New York. Design, Setting, and Participants This is a descriptive study of adult patients, who received MAB therapy between November 20, 2020, to January 31, 2021, and a retrospective cohort survival analysis comparing patients who received MAB therapy prior to admission versus those who did not. Main outcomes and measures The primary outcome was in-hospital mortality; additional evaluations included ED utilization and hospitalization within 28 days of a positive COVID-19 test for patients who received MAB therapy. Results During the study period, 2818 (1412 [50.1%]) male, (1406 [49.9%] female) adult patients median age 67 years (IQR 58-74) with symptomatic COVID-19 received MAB infusion. Following therapy and within 28 days of COVID-19 test, 145 patients (5.1%) were hospitalized and compared with 200 controls who were eligible for but did not receive MAB therapy, and were hospitalized. In the MAB group, 16 (11%) patients met the primary outcome, versus 21 (10.5%) in the control group (not significant, log rank p-value = 0.41). In an unadjusted proportional hazards model, no significant association was found between pre-hospitalization MAB use and time to the primary end point (HR 1.38, 95% CI 0.696-2.719) as well as in models adjusting for demographics (HR 1.1, 95% CI 0.53-2.23), demographics and Charlson Comorbidity Index (CCI) (HR 1.22, 95% CI 0.573-2.59), and with inverse probability weighting according to propensity scores (HR 1.19, 95% CI 0.619-2.29). Reduced hospitalization rate was related to the time between symptom onset and MAB therapy (4.4% within 0-4 days, 5% within 5-7 days, and 6.1% within [≥]8 days) however, this finding did not reach statistical significance (p-value = 0.15). Conclusions and relevance Establishing the capability to provide MAB infusion therapy requires significant planning and coordination. While this therapy may be an important treatment option for early mild to moderate COVID-19 in high-risk patients, further investigations are needed to define the optimal timing of MAB treatment.